Explaining Health Plan Accreditation (HPA) 2022 Series

October 7, 2021 to November 4, 2021

Course Description

Faculty will equip participants with guidance for interpreting the requirements, navigating the standards, and avoiding misconceptions. Faculty will also facilitate short activities to simulate how to address requirements. This course is appropriate for any professional with either a direct or indirect stake in NCQA Accreditation.

This course presents information based on the requirements from the HPA 2022 Standards. Therefore, the content of this course applies directly to NCQA Accreditation Surveys conducted between July 1, 2022 and June 30, 2023.  For courses pertaining to Delegation requirements, please use “Delegation” to search NCQA courses at ncqa.org/education.

Note: Each attendee must register as a unique participant, as required by the NCQA Terms of Use

Group Training?
For inquiries regarding group training rates, please complete our online form.

Key Topics

Credentialing (CR) 
Live Webinar: October 25, 2021, 1:00 pm - 4:00 pm ET

•    Controlling credentialing systems. 
•    Managing credentialing committee.
•    Administering credentialing verification.
•    Monitoring interventions continuously. 
•    Assessing organizational providers.

Network Management (NET) 
Live Webinar: October 7, 2021, 1:00 pm - 4:00 pm ET

•    Evaluating adequacy of networks.
•    Conducting qualitative and quantitative analyses.
•    Demonstrating timeliness for network decisions.
•    Assessing out-of-network utilization.
•    Measuring effectiveness of interventions.

Utilization Management (UM)
Live Webinar: October 14 2021, 1:00 pm - 4:00 pm ET

•    Controlling UM systems.
•    Handling member appeals.
•    Determining coverage and medical necessity.
•    Administering denial notices.

Member Experience (ME)
Live Webinar: October 21, 2021, 1:00 pm - 4:00 pm ET

•    Communicating benefits with clarity and accuracy.
•    Distributing subscriber information.
•    Measuring quality and accuracy of communications.
•    Supporting members with benefit related decisions.

Population Health Management (PHM) 
Live Webinar: October 27, 2021, 1:00 pm - 4:00 pm ET

•    Constructing a comprehensive PHM strategy. 
•    Assessing patient populations.  
•    Managing complex cases. 
•    Managing value-based payment arrangements. 

Quality Management and Improvement (QI)
Live Webinar: November 4, 2021, 1:00 pm - 4:00 pm ET

•    Planning, evaluating, and controlling QI interventions. 
•    Incorporating contracted practitioners and providers into QI.
•    Coordinating care across the network. 
•    Measuring effectiveness of QI interventions.

Benefits and Resources
•    Presenting Slides. 
•    Recording of Live Session.
•    Live Q&A. 
•    Scenarios for Applied Learning.
•    Perspective from Former NCQA Policy Staff.
•    ACCME Credits for Clinicians. 

Target Audience

•    Clinicians, Directors, Managers, Specialists, and Coordinators
•    Consultants, Contractors, Delegates, and Vendors
•    Health Plans and Managed Care Organizations
•    Professionals in Provider Relations 
•    Professionals in Population Health or Public Health
•    Professionals in Compliance, Public Policy, or Risk Management
•    Professionals in Quality Assurance/Improvement or Performance Measurement

Learning Objectives

  • Explain the intent of the HPA Standards.
  • Define performance issues and target results within the scope of requirements.
  • Describe relationships and themes across the Elements for CR, NET, UM, ME, PHM and QI.
  • Discuss requirement implications and considerations for stakeholder group.
  • Critique examples and scenarios to enhance application.
Course summary
Course opens: 
08/17/2021
Course expires: 
12/31/2022
Event starts: 
10/07/2021 - 1:00pm
Event ends: 
11/04/2021 - 4:00pm
Cost:
$1,650.00

Clint Koenig, MD, MSPH, MA

Clint Koenig, MD, MA, MSPH is the senior Medical Director at Ohio Healthy, a new system-based health plan in Columbus Ohio. He has served as State Medical Director in New Hampshire and Ohio. Other leadership roles include the Health Plan Regional Chief Medical Officer at Universal American, a government programs health management organization in Syracuse New York as well as the Director for Utilization Management at Monroe Plan for Medical Care, a healthcare management organization in Rochester, New York. In addition, Clint held Chief Medical Officer roles in Federally Qualified Health Centers and integrated delivery systems.

He has been an NCQA surveyor for 10 years and surveys health plans, Patient Centered Medical Home, Special Needs Plans and Long Term Services and Supports organizations.

Dr. Koenig received his MD from Albany Medical College in Albany, NY. He completed his residency in Family Medicine, from the University of Missouri. He also completed a fellowship at the University of Missouri, where he received Masters degrees in Public Health and Journalism.

Shelly Smith, RN, MN, CPHQ

Shelly Smith is an NCQA surveyor and recently retired owner and Managing Consultant of Health Value Solutions, LLC, an independent healthcare consulting firm based in Liberty Lake, Washington. She has extensive experience in the development and implementation of health plan quality programs, disease management program development, worksite wellness program implementation and development of provider health care quality measurement and pay for performance programs.  Through collaborative communication, Shelly is a proven leader in the successful preparation for health plan NCQA accreditation both as a health plan leader and external consultant and has provided successful consultation and leadership in vendor, employer group and provider environments.

Shelly brings over 30 years’ experience in the health care industry having held staff and leadership positions in both the hospital and health plan setting. She started her career as a registered nurse and spent 4 years working with cardiovascular medical, surgical and transplant patients.  After completing her Master’s degree, Shelly transitioned to administrative roles where she served for over 15 years as both the Quality Manager and later Director of Quality with Medical Service Corporation and Premera Blue Cross. In these roles she led 5 successful NCQA accreditation efforts including commercial, Medicaid and Medicare membership, maximized HEDIS results, developed physician pay-for-performance programs and implemented successful disease management and employer-based wellness programs. She formed Health Value Solutions in 2008 and has worked with numerous health plans and vendors throughout the United States to achieve successful NCQA accreditation/certification since that time.  Shelly has been a surveyor for the National Committee for Quality Assurance (NCQA) since 1996. She has been faculty for Blue Cross Blue Shield Association NCQA training earlier in her career and served as faculty for NCQA Surveyor Update training, Intro to Accreditation and Advanced Accreditation seminars in recent years.

Ms. Smith holds a Masters’ Degree in Cardiovascular Physiological Nursing, a Bachelors’ degree in Nursing, and a National Certification in Healthcare Quality. 

Joseph Stankaitis, MD, MPH 

Joseph A. Stankaitis, MD, MPH since 1997 has been the Chief Medical Officer of the Monroe Plan for Medical Care, an Individual Practice Association (founded in 1970) and healthcare management organization in Rochester, New York and the Chief Medical Officer of its safety-net health plan, YourCare Health Plan in Upstate and Western New York. He oversees all clinically-related activities for these organizations, including its Health and Recovery Plan (HARP) for the Seriously Mentally Ill. He is also the Principle Investigator for Monroe Plan’s SAMHSA Grant, “Addressing Buffalo’s Opioid Epidemic with Medication Assisted Treatment.”

He is a Fellow of the American College of Physicians, Fellow of the American Association for Physician Leadership and Clinical Associate Professor of Family Medicine at the University of Rochester School of Medicine and Dentistry. He is an active reviewer and past Chair of the Review Oversight Committee and current Chair of the Reconsideration Committee for the National Committee for Quality Assurance (NCQA). He is a member of the New York State Department of Health Medicaid Evidence-Based Benefits Review Advisory Committee. He is the President of the American Diabetes Association (ADA) Rochester Volunteer Leadership Board and has served as a member of the ADA’s National Professional Practice Committee (develops national practice guidelines for diabetes care).

Dr. Stankaitis received a bachelor’s degree in biology from Boston College, his MD from the University of Connecticut and completed his residency and chief residency in the Primary Care Program in Internal Medicine at the University of Rochester. As a Kellogg Foundation Fellow at Harvard University, he received a Master’s degree in Health Policy and Management.

Frank H. Stelling, M.Ed, MPH

Mr. Stelling is a Senior Consultant with The Mihalik Group. Prior to joining the Mihalik Group, he was Assistant Director, Accreditation Policy at NCQA for 14 years. Mr. Stelling oversaw the Policy Clarification Support System (PCS), a web-based tool for customers to ask questions of Policy Accreditation staff concerning all NCQA Accreditation and Certification programs. He also directed all education efforts out of the Policy Accreditation unit. In addition, Mr. Stelling was the lead on all federal and state deeming activities, including the Medicare Deeming program.

Mr. Stelling is also an NCQA surveyor and has been part of survey teams for the accreditation of Health Plans, Managed Behavioral Health Organizations. Disease Management Organizations and other organizations for over 17 years. Mr. Stelling has over 40 years of experience in health care with focus on Preventive Services, Disease Management and Quality Improvement.

Before joining NCQA, he held management positions with state and county health departments, hospitals, voluntary health organizations and a managed care organization. He holds a Master of Education from the University of South Carolina and a Master of Public Health from the University of California, Berkeley.

Veronica Locke, MHSA

Veronica Locke is a consultant for The Mihalik Group, providing healthcare-related consulting services.  Her areas of expertise include quality assessment and improvement; credentialing; delegation; disease management accreditation/certification; population health management; multicultural health care.

Veronica is the former Senior Manager of Accreditation Policy for the National Committee for Quality Assurance. She was actively involved in the development and maintenance of the standards and guidelines of NCQA's Accreditation and Certification programs, specifically Health Plan, Disease Management and Multicultural Health Care Distinction programs. As a member of the Policy team, one of her major responsibilities was to serve as a content champion when providing policy clarifications and trainings internally and externally.

She received her Bachelor of Science Degree in Public Health from the University of Maryland, College Park and her Master of Health Systems Administration Degree from Georgetown University in Washington, DC.

 

 

 
The Credits listed below will be provided at the individual Course Level.

In support of improving patient care, the National Committee for Quality Assurance is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), the American Nurses Credentialing Center (ANCC), the American Academy of Physician Assistants (AAPA), the American Psychological Association (APA), and the Association of Social Work Boards (ASWB) to provide Interprofessional Continuing Education for the healthcare team. 

Explaining HPA 2022: Credentialing (CR)

This activity was planned by and for the healthcare team, and learners will receive 3.0 Interprofessional Continuing Education (IPCE) credit for learning and change.

This educational activity is approved for: 3.0 AMA PRA Category 1 CreditTM, APA, AAPA, ACPE and ASWB ACE.

This educational activity is approved for 3.0 nursing contact hours.*

The assigned universal program number: . Upon successful completion of this program (attending the full session and completing a program evaluation), participants will access CPE Monitor on the ACPE website to locate and track their CPE statement of credit.

This live course grants 2.0 Continuing Education Unit (CEU) points for PCMH Certified Content Experts.  

* Please note – You must attend the entire program to be eligible for total number of contact hours.


Explaining HPA 2022: Network Management (NET)

This activity was planned by and for the healthcare team, and learners will receive 3.0 Interprofessional Continuing Education (IPCE) credit for learning and change.

This educational activity is approved for: 3.0 AMA PRA Category 1 CreditTM, APA, AAPA, ACPE and ASWB ACE.

This educational activity is approved for 3.0 nursing contact hours.*

The assigned universal program number: JA0004597-0000-21-012-L04-P. Upon successful completion of this program (attending the full session and completing a program evaluation), participants will access CPE Monitor on the ACPE website to locate and track their CPE statement of credit.

This live webinar grants 2.0 other Continuing Education Unit (CEU) points for PCMH Certified Content Experts.  

* Please note – You must attend the entire program to be eligible for total number of contact hours.


Explaining HPA 2022: Utilization Management (UM)

This activity was planned by and for the healthcare team, and learners will receive 3.0 Interprofessional Continuing Education (IPCE) credit for learning and change. 

This educational activity is approved for: 3.0 AMA PRA Category 1 CreditTM, ANA CNE, APA, ACPE and ASWB ACE.

The assigned universal program number: JA0004597-0000-21-010-L04-P. Upon successful completion of this program (attending the full session and completing a program evaluation), participants will access CPE Monitor on the ACPE website to locate and track their CPE statement of credit.

This live webinar grants 2.0 other Continuing Education Unit (CEU) points for PCMH Certified Content Experts.  

* Please note – You must attend the entire program to be eligible for total number of contact hours. 


Explaining HPA 2022: Member Experience (ME)

This activity was planned by and for the healthcare team, and learners will receive 3.0 Interprofessional Continuing Education (IPCE) credit for learning and change. 

This educational activity is approved for: 3.0 AMA PRA Category 1 CreditTM, ANA CNE, APA, ACPE and ASWB ACE.

The assigned universal program number: JA0004597-0000-21-013-L04-P. Upon successful completion of this program (attending the full session and completing a program evaluation), participants will access CPE Monitor on the ACPE website to locate and track their CPE statement of credit.

This live webinar grants 2.0 other Continuing Education Unit (CEU) points for PCMH Certified Content Experts.  

* Please note – You must attend the entire program to be eligible for total number of contact hours. 


Explaining HPA 2022: Population Health Management (PHM)

This activity was planned by and for the healthcare team, and learners will receive 3.0 Interprofessional Continuing Education (IPCE) credit for learning and change. 

This educational activity is approved for: 3.0 AMA PRA Category 1 CreditTM, ANA CNE, APA, ACPE and ASWB ACE.

The assigned universal program number: JA0004597-0000-21-011-L04-P. Upon successful completion of this program (attending the full session and completing a program evaluation), participants will access CPE Monitor on the ACPE website to locate and track their CPE statement of credit.

This live webinar grants 2.0 other Continuing Education Unit (CEU) points for PCMH Certified Content Experts.  

* Please note – You must attend the entire program to be eligible for total number of contact hours. 


Explaining HPA 2022: Quality Management & Improvement (QI)

This activity was planned by and for the healthcare team, and learners will receive 3.0 Interprofessional Continuing Education (IPCE) credit for learning and change. 

This educational activity is approved for: 3.0 AMA PRA Category 1 CreditTM, ANA CNE, APA, ACPE and ASWB ACE.

The assigned universal program number: JA0004597-0000-21-009-L04-P. Upon successful completion of this program (attending the full session and completing a program evaluation), participants will access CPE Monitor on the ACPE website to locate and track their CPE statement of credit.

This live webinar grants 2.0 other Continuing Education Unit (CEU) points for PCMH Certified Content Experts.  

* Please note – You must attend the entire program to be eligible for total number of contact hours. 

 
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$330.00Included
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Price

Cost:
$1,650.00
Please login or register to take this course.

Registration
Registration for this “Explaining Health Plan Accreditation (HPA) 2022 Series” has been set up to allow you to purchase all six of the Explaining HPA 2022 Live webinars at the discounted rate of $1650.00. To get this discount, select the top box on the right side of the chart below.  Note: the box next to each individual course will turn grey when all courses are selected.

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